Dentures In General Flashcards
To create immediate dentures, is it just primary imps or do you carry out secondary imps & jaw reg as described in the ppt?
Depends upon case - if there are no existing gaps in the dentition then you may just do primary imp, interocclusal record and shade then go straight to finish, or if existing spaces you may go through every usual denture-making stage (may combine secondary imps with jaw reg?)
What is the neutral zone impression and how long is it kept in the mouth for? And when may it be used?
You really don’t need to know too much about this technique. It is a way of establishing where the zone of least interference / neutral zone is (by adding impression material to the top of a mandibular acrylic base plate, which is then moulded by surrounding tissues), so that the denture teeth can be set in that zone to assist with stability.
- It may be used in cases where there is unusual anatomy (e.g. following resection of part of the tongue following oral cancer). If you look at the reline powerpoint there are links to a paper about this which will give further details. And what material is used (tissue conditioner?)? Yes, or can be light body silicone?
Older people - systemic issues and oral concerns
- Physical disability
- Heavily restored (and failing) dentition
- Limited finances
-Cardiovascular disease - Periodontal disease
- Difficulty accessing transport
- Cognitive impairment
- Caries (incl. Root caries)
- Low dental awareness
- Diabetes
- Gingival recession
- Low motivation to change diet/habits
- Reduced manual dexterity
- Broken down teeth/worn dentition
-Social isolation
Poor neuromuscular control Sclerosedroot canals
Consent issues
Polypharmacy
Dry mouth
Radio/ Chemotherapy
Tooth surface loss
Bisphosphonates
Missing teeth
Alteredimmune system
Denture problems
Hearing difficulties
Complex restorative challenges
Factors to consider with older people and retaining teeth/preserving teeth (9)
- Extent of caries/restorations and associated symptoms.
- Periodontal support.
- Standard of oral hygiene: patient and/or carer.
- Previous denture experience: manual dexterity.
- Extent of tooth surface loss.
- Position of teeth e g. overerupted, tilted, occlusal stops, free-end saddles etc. Are they a help?
- Contour of the alveolar ridges following previous extractions.
- AGE - biological/medical infirmity may complicate.
- Patients expectations of and wishes for treatment
Denture longevity: time and reasons for eventual failure/wear
- Both partial and complete = 5-7 years
- COMPLETE:
- Reduction in colour due to agents leaching out
- Wear of teeth
- Repeated fractures
- PARTIAL:
- Same as complete but also loss of clasp retention due to metal fatigue
- Wear of rest seats/pts natural teeth
When to retain teeth before making denture (5)
- Restorable
• Periodontally sound
• Cleansable
• Pt’s wants/ desire- must warn of consequences
• Grade I/ll mob
When to extract teeth before making denture (5)
- Root #; pain; infection
• Not cleansable/plaque trap
• Subgingongival and open communication to oral cavity
• Grade Ill mob
• Part of immediate denture iX plan?
PESH - perio, endo, structure, holistic
What tx options are there if only mandibular canines and incisors remain? What do you need to consider (5)
- fixed and removable options
- retaining vs XLA some/all teeth
- immediate denture approach vs conventional
- appropriate materials (acrylic vs CoCr)
- use of over denture roots/implants
Considerations with overdentures (5)
- Crown to root ratio
- Pattern of resorption
- Prognosis for endodontic treatment (is the pulp already sclerosed)
- Consider secondary caries with gold copings
- For maintaining them, think about applying fluoride toothpaste (5000ppm) in the overdenture and wearing them.
Prevention:
- Improve oral cleaning - consider electric toothbrushes
- Dietary control
- Fluorides - toothpastes; mouthrinses; high fluoride varnishes or toothpastes
- Large toothbrush handles to compensate for dexterity
Overall issues with complete opposing natural/partial
- Natural tooth position - teeth tilted or drifted.
- Occlusal plane - overeruption, tilting of plane.
- Freeway space - may be increased or absent.
- Balanced occlusion is impossible against natural teeth.
- Greater force applied by natural teeth greater than by C/C
- Adverse bone resorption patterns due to local overloading
- Difficulty in recording jaw relationships.
- Appearance
How to repair fractured denture using the lab
Obvs check how many pieces, if more than 2 pieces or complex fracture then may need remake
Otherwise put denture into mouth and take in situ imp and send to lab for repair
Chairside = cold cure acrylic ?
What do you need to think about in terms of management and risks of keeping vs losing teeth
Better candidates (distinction level) will give examples, e.g. haematological condition/neoplasia will affect infection resistance, healing and bleeding/clotting - affect management of periodontally involved teeth. Diabetes infection resistance, healing and affect management of periodontally involved teeth. High dosage bisphosphonate for tumour management - risk of osteonecrosis would need advice on management of remaining teeth as risk to keep and risk to lose.
Social History and Expectations
The following insight would be shown by distinction/high performing candidates.
Factors e.g. smoking may affect treatment options - periodontal management/implants. Alcohol consumption - compliance. Mobility can affect elderly obtaining care. Dementia again even early dementia can affect the ability of patients to undertake complex care or maintain long-term.
General options for upper natural teeth and lower complete denture
• Stabilisation phase successful and periodontal condition improved. Consider an RPD. Better candidate’s insight, reduced number of teeth so a CoCr denture may not be successful (especially in view of the periodontal issues) as not possible to retain it without clasps. Therefore, best option is an acrylic resin mucosa supported denture.
As there is no indication to past denture experience in the upper arch the acrylic denture can be modified easily e. g. palatal coverage.
• Consider overdenture option - reduction of crown-to-root ratio may reduce load to compromised root. Canine is key abutment with longest root and possibly accessible canal. RCT may consider specialist/experienced practitioner advice/treatment.
Provide an upper immediate denture, although may make RPD first then ad eeth rather than go straight to an immediate denture (distinction level insight
• Extract teeth and leave to heal and construct a complete denture.
Assessment of the Mandibular Arch:
No information of the anatomy/ridge shape/resorption of the lower foundation.
So examination of foundation with and without denture.
Flat resorbed ridge - may not offer stability but was old denture extended into retromylohyoid fossa etc.
Lower denture worn for 8-years so likely to have been originally successful (Better candidate’s insight)?
As the patient is finding the denture uncomfortable, as past of the treatment strategy it would sensible to make the current set as comfortable as possible and allow healing of damaged soft tissue.
Extension and fit problems may be identified with pressure indication paste and the base adjusted. A soft/temporary lining prior to impression taking (again this detail is not expected from a just passing candidate but some insight into planning and execution of complete dentures).
Options a new lower denture either conventional primary impressions with a viscus material e.g. silicone putty, secondary impressions e.g. zinc oxide and eugenol in a close-fitting tray (just passing candidate may not have sufficient time for this detail).
May even consider a permanent soft-lining (higher performing candidates).
A denture worn for many years may have been well designed originally, so a “denture copying technique” could be considered.
An option is the stabilisation of the lower denture with dental implants (implant stabilised overdenture with 2-dental implants). It may be possible to plan this in the maxilla depending upon bone height, width and quality, usually in the anterior mandible there are no issues.
Option beyond scope of safe beginner so would need to refer to specialist/experienced practitioner.
